Cataract surgery announcement - thousands more eligible

Thousands more New Zealanders will get cataract surgery and a new nationwide surgical threshold will end the “postcode lottery” in access to the life-changing operation.

Patients, optometrists and ophthalmologists have been campaigning for the change for years.

An ongoing Herald investigation has highlighted cases where people cannot easily drive or continue working but don’t qualify, whereas if they lived in another region like Auckland they would easily do so.

The Royal Australian and NZ College of Ophthalmologists (Ranzco) has lobbied for a nationwide surgical threshold, to be set at the same level as Auckland’s.

This afternoon, Health Minister Ayesha Verrall confirmed that would happen, which will require an initial 3500 more cataract surgeries to be done.

Regional health authorities would be “working towards” the new nationwide surgical threshold, Verrall said, and will identify patients who are newly-eligible.

“In some places it will take up to 18 months to phase that in.”

Public hospitals are at or near capacity, so many surgeries will be outsourced to the private sector.

Patients needing planned care (medical or surgical services that aren’t required immediately, often called electives) are frequently given a score from 0 to 100 (lowest to highest priority), mostly according to clinical and social needs.

This is called the Clinical Priority Assessment Criteria (Cpac) score.

If the score reaches a certain threshold, the patient will be accepted for surgery, which should happen within four months (a timeframe set by the Government).

Thresholds are regularly changed, to try to ensure patients who are accepted are treated within the four-month wait time.

Health Minister Ayesha Verrall. Photo / Mark Mitchell

The Cpac score needed to get cataract surgery varied widely under the old DHB system, and this regional difference continued after the 20 DHBs were replaced by the single entity, Te Whatu Ora - Health NZ, one year ago.

Problems including restricted operating theatre availability has meant the Cpac threshold in the Southern region, which covers Dunedin, Queenstown and Invercargill, is the harshest in the country, at 61.

The lowest is 46, in Auckland and Waitematā. Counties Manukau, Hawke’s Bay and West Coast (South Island) are slightly higher at 48.

Other regions with a high threshold for surgery include Capital & Coast (Wellington), Nelson Marlborough and Lakes, which covers Taupō and Rotorua.

Today, Verrall announced that the nationwide threshold would be set at 46.

“A score of 46 represents mildly reduced vision. A score of 61 represents poor vision and meant that the person could no longer legally drive.”

Verrall said the Budget had allocated $118 million to tackle waiting lists, and there will be more announcements about other services.

Wait lists are at record lengths, and the enormous strain on an under-staffed health system has become a major election-year issue.

Over 56,000 New Zealanders were waiting longer than four months for a first specialist appointment at the end of April, with another 34,662 similarly overdue for treatment.

(A patient is considered overdue if they wait longer than four months after being accepted for a specialist appointment or treatment.)

People unlucky enough to live in areas with high thresholds for cataract surgery - and who cannot afford the approximate $5000 cost to go private - have endured major vision loss.

A recent study analysed all 44,000 patients referred for cataract surgery from 2014-2019, and found more than a quarter declined surgery “did not meet the visual acuity requirement for driving a private vehicle in NZ”.

Māori and Pacific patients develop cataracts at a younger age, the research found, and “have worse visual acuity and typically severe visual impairment, compared to other ethnic groups at the time of prioritisation”.

Elizabeth Kerslake was one of those who endured major vision loss - her cataracts caused headaches and, on sunny days, made her reluctant to drive - but the Queenstown resident still didn’t meet the threshold for cataract surgery.

If Kerslake, 72, lived in Auckland, she would have easily qualified for surgery.

After the Herald featured her plight in a story in April, a reader anonymously paid for her to get the surgery done privately.

Today, Kerslake said she was “thrilled to bits” to know a nationwide surgical threshold would be introduced, as it would stop others from enduring such significant vision loss.

The Herald highlighted the unfairness of access to cataract surgery in a March 2019 investigation, and in numerous follow-up stories.